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Extreme violence has been inflicted on civilians for more than seven years due to the war in Syria. Access to food and health care remains poor across many parts of the country.

Doctors Without Borders/Médecins Sans Frontières (MSF) provides lifesaving medical care through a combination of direct operations, local partnerships, and distance support to dozens of health facilities.

647,600

outpatient

consultations in 2017

23,000

relief kits

distributed

10,000

major surgical

interventions

Civilian areas have been bombed, held under siege, and deprived of assistance. Many hospitals have been destroyed or face critical shortages of supplies and staff. Well over half of the Syrian population have been forced from home by the conflict, and many have been displaced multiple times.

Intense fighting, including air strikes and ground shelling, dramatically intensified in northern Syria after December 2017, fueling one of the largest displacements of people since the war began. Tens of thousands of newly uprooted families were forced to find space among the hundreds of thousands of displaced people already crowded into northern Idlib governorate. Many had no shelter and were exposed to frigid conditions. MSF teams distributed hygiene and winter supply kits to families, and provided medical supplies and additional support to key health care facilities and emergency referral centers in the area.

“Patients tell us that land mines, booby traps, and other improvised explosive devices are planted in fields, along roads, on the roofs of houses, and under staircases,” said Satoru Ida, MSF head of mission in Syria. “Household items like teapots, pillows, cooking pots, toys, air conditioning machines, and refrigerators are also reportedly rigged to explode as people return home for the first time after months or years in displacement.” MSF’s emergency clinic in Raqqa city has treated hundreds of victims of explosives. Increased demining action and risk education are urgent, alongside improved access to emergency medical care.

As of April 2018, we directly operated five health facilities and three mobile clinics in northern Syria, and had partnerships with five facilities. MSF also provided distance support to about 50 health facilities in areas of Syria where teams cannot be directly present. MSF's activities in Syria do not include areas controlled by the Islamic State group, since no assurances regarding safety and impartiality have been obtained from their leadership. In addition, MSF is unable to work in government-controlled areas since its requests for permission have, to date, not resulted in any access. To ensure independence from political pressures, MSF receives no government funding for its work in Syria.

Medical facilities, staff, and patients are often the victims of indiscriminate and targeted attacks. During the battle for control over the besieged enclave of eastern Ghouta, 15 out of 20 facilities supported by MSF were hit by bombing or shelling over a two-week period from February 18 to March 4, 2018. Over that same period, MSF-supported facilities in the area reported receiving massive casualties: more than 4,800 wounded and more than 1,000 dead.

Syria: Voice from a hospital basement in eastern Ghouta

In 2017, civilians were caught in the months-long military offensive by the Syrian Democratic Forces (SDF) and an international coalition to capture Raqqa from the Islamic State (IS) group. People trapped in the city and surrounding areas faced impossible choices: whether to stay put under heavy bombardment or risk escape, facing the threat of reprisals from IS as well as the dangers of crossing active front lines and minefields. MSF operated ambulances close to the front lines, in partnership with local health authorities, and supported an advanced medical post outside Raqqa city. MSF teams run a clinic for displaced people in Ain Issa camp and work in areas in the northeast that were previously off limits under IS control.

Dangers can persist long after the fighting subsides. Displaced people returning to their homes in Raqqa, Hassakeh, and Deir ez-Zor governorates are at risk of land mines and improvised explosive devices. The number of patients treated for related injuries at one MSF-supported hospital in Hassakeh, in northeast Syria, doubled in the early months of 2018. More than half of those injured were children.